Done by: Tamador A. Zetoun Heart failure Done by: Tamador A. Zetoun

Heart Failure … Means failure of heart to pump enough blood to satisfy the need of the body. Due to an impaired ability of the heart to adequately to fill or eject blood.

HEART FAILURE Heart failure (HF) means decreased ability of the heart to perform its proper pumping action (due to decreased force of contraction of the ventricles). HF may be left-sided HF or right sided HF or both (congestive HF).

Left-sided heart failure Right-sided heart failure Causes: Systemic hypertension (chronic or untreated). Coronary heart disease  myocardial infarction in the LV. Aortic stenosis or incompetence (valvular disease). Pulmonary hypertension Mitral stenosis pulmonary hypertension. Left sided heart failure

Pathophysiology of Heart Failure

Pathophysiology of Heart Failure Molecular & Cellular changes

HEART FAILURE COMPENSATED ACUTE HF 1-Baroreceptorse 2-Chemoreceptors 3-CNS Ischemic response 4-Activate of sympathetic activity 5-Increase circulatory filling pressure 6-Increase venous return

HEART FAILURE CHRONIC STAGE OF FAILURE 1-Renal function, renin angiotensin 2-Increase aldosterone 3-Increase sympathetic stimulation 4-Fluid retention 5-Role of atrial Natriuretic peptide

Decompensate HF The heart become severely damage even with all compensatory mechanism of the body.

TYPES OF HEART FAILURE 1-Left , right and congestive HF 2-Acute and chronic 3-Systolic and diastolic HF 4-High cardiac output HF

Clinical assessment 1-LVF : Dyspnea, orthopnoea, PND, inspiratory crepitation and pulmonary edema. Poor tolerance , cold extremeties , low BP, oliguria and uraemia . 2-RVF: Increase jugular venous pressure, peripheral edema, hepatomegaly, splenomegaly, ascites , and pleural effusion. 3- Congestive HF : 1+2

COMPLICATIONS 1- Renal failure 2- High or low K, by the effect of treatment (drugs) 3-Hyponatremia 4- Impair liver function 5-DVT and pulmonary embolism 6-Arrhythmias

SHOCK - Shock is a clinical syndrome characterized by inadequate tissue perfusion due to decreased cardiac output and decreased ABP (hypotension). (Cold skin, Hypotension and confusion or coma). It is generally classified into 4 types: 1. Hypovolemic shock 2. Low-resistance shock 3. Cardiogenic shock 4. Obstructive shock

HYPOVOLAEMIC SHOCK CARDIOGENIC SHOCK - It occurs a result of - It occurs as a result of decreased pumping excessive loss of blood or plasma, e. action of the left ventricle Haemorrhagic shock e.g. due to: Traumatic shock Myocardial infarction. Surgical shock Severe ventricular Burn shock tachycardia - It is also called cold shock.

LOW-RESISTANCE SHOCK OBSTRUCTIVE SHOCK It occurs as a result of - This occurs as a result massive vasodilatation of obstruction of blood   circulatory capacity flow in the lungs or and dec venous return Heart e.g. due to a large   COP   ABP e.g. pneumotorax. Cardiac neurogenic shock, tamponade or massive anaphylactic shock embolismpulmonary embolism. (histamine shock)

SEPTIC SHOCK 1-High temp 2- Normal BP 3- Normal Co 4- Warm skin

DEGREES OF SHOCK 1-Nonprogressive or compensated shock 2- Progressive or noncompensated shock 3- Irreversible shock

EFFECTS OF HAEMORRHAGE The following effects are produced by haemorrhage: Hypotension: because the loss of blood   blood volume   C.O.P.   A.B.P. Rapid and weak pulse: and in severe haemorrhage, the pulse is hardly felt.  Respiration in rate and depth. Pale and cold skin: the skin is pale due constriction of skin capillaries and it is cold due to constriction of skin arterioles   blood volume passing through the skin.  Urine Formation: due to  renal blood flow and  secretion of antidiuretic hormone. Fainting (=loss of consciousness) and death may occur in severe haemorrhage due to brain ischaemia.

EFFECTS OF HAEMORRHAGE Hypotension ( ABP)  inadequate perfusion Cerebral hypoxia (ischaemia)  depression of brain (cortex and centers)  coma. BODY REACTION TO HAEMORRHAGE Compensatory reactions in acute haemorrhage Immediate compensatory reactions Immediate reactions aim at rapid elevation of the arterial B.P. 1. Reactions that correct the hypovolaemia: (a) Capillary fluid shift from the tissue spaces to the bloodstream (b) Mobilization of the labile tissue protein into the bloodstream (c) Splenic contraction (which adds the stored blood in the spleen to the circulating blood).

Summary BODY REACTION TO HAEMORRHAGE Immediate Compensatory Delayed Compensatory Reactions Reactions  heart rate   COP  Secretion of ADH & Vasoconstriction of aldosterone  retention arterioles (PR) of water   plasma volume. Venoconstriction   VR  Mobilization of labile Contraction of spleen. and reserve proteins  secretion of adrenaline & from the tissues to the Noradrenaline   plasma proteins.

Activation of   formation of renin-agiotensin sys erythropoietin    secretion of vaso-pressin production of RBCs (ADH). Capillary fluid shift  urine formation. These reactions restore blood pressure and blood volume in mild or moderate haemorrhage.

TREATMENT OF SHOCK